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Einheilung vaskularisierter Knochenallotransplantate

Optimierung durch Kurzzeit-Immunsuppression und der empfängerbasierten Neovaskularisation

Healing of free vascularized bone allotransplants

Optimizing by short-term immunosuppression and host-derived neovascularization

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Zusammenfassung

Hintergrund

Vaskularisierte Knochenallotransplantate (AT) bedürfen derzeit der Langzeit-Immunsuppression (IS), was für den Extremitätenerhalt nur schwer zu rechtfertigen ist. Eine alternative Methode, um das Überleben der Transplantate zu ermöglichen, besteht in der empfängerbasierten Neovaskularisation während einer Kurzzeit-IS.

Material und Methoden

In Hollandkaninchen wurden diaphysäre Femurdefekte durch mikrochirurgisch revaskularisierte AT von Neuseelandkaninchen rekonstruiert. Zusätzlich erfolgte die intramedulläre Platzierung eines Faszienlappens vom Empfänger sowie Kurzzeit-IS in 2 von 4 Gruppen. Die Vaskularisation und Einheilung wurden mittels Mikroangiographie und eines Röntgenscores untersucht.

Ergebnisse

Knochen-AT mit durchblutetem Faszienlappen und Kurzzeit-IS hatten die höchste Neovaskularisationsrate und heilten ähnlich schnell ein wie vaskularisierte Autotransplantate ohne signifikantem Unterschied in den Röntgenscores. Vaskularisierte AT ohne diese Kombination waren unterlegen.

Schlussfolgerung

Der gesteigerte Knochenumbau erlaubt eine gute Heilung. Das Transplantat kann vorübergehend geschwächt sein, jedoch wird möglicherweise durch intensivere Remodellierung mit Empfängerzellen auf lange Sicht ein stabilerer Knochen erzielt als bei avaskulären Transplantaten.

Abstract

Background

Living bone allotransplants (ATs) currently require long-term immunosuppression (IS), but this is impractical for extremity-preserving procedures. An alternative method to maintain viability of the transplant uses host-derived neoangiogeneic vessels combined with short-term IS.

Materials and Methods

Diaphyseal femoral defects in Dutch-Belted rabbits were reconstructed with a free microvascular AT from New Zealand White rabbits. Additionally, a host-derived intramedullary pedicled fascial flap was placed and short-term IS administered to two of four groups. Neovascularization and bone healing were quantified by microangiography and a custom radiographic score.

Results

Bone ATs with perfused fascial flaps achieved bone healing equivalent to autotransplant controls, even when they received IS only until host-derived neoangiogenesis replaced the original perfusion. Vascularized ATs without this combination achieved significantly inferior results.

Summary

This rabbit model demonstrated that increased bone turnover allows good healing but may temporarily weaken the allotransplant. However, by the more intense replacement of the graft with host-derived cells, this process may, in the long-term, ultimately result in a better transplant than an avascular graft.

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Authors and Affiliations

  1. Klinik für Hand, Plastische und Rekonstruktive Chirurgie, Schwerbrandverletztenzentrum, BG Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen am Rhein, Deutschland

    G.A. Giessler

  2. Department of Orthopedic Surgery, Microvascular Research Laboratory, Mayo Clinic, Rochester/MN, USA

    P.F. Friedrich, R.H. Shin & A.T. Bishop

Authors
  1. G.A. Giessler
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  2. P.F. Friedrich
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  3. R.H. Shin
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  4. A.T. Bishop
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Correspondence to G.A. Giessler.

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Giessler, G., Friedrich, P., Shin, R. et al. Einheilung vaskularisierter Knochenallotransplantate. Unfallchirurg 112, 479–486 (2009). https://doi.org/10.1007/s00113-008-1525-6

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  • DOI: https://doi.org/10.1007/s00113-008-1525-6

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